Results of ascending aortic and arch replacement for type A aortic dissection

Abstract Objective The outcomes of emergent surgery for type A acute aortic dissection (TAAAD) have improved. However, ascending aortic replacement (AAR) sometimes leads to dilatation of the distal aorta. The present study reviewed our outcomes of AAR and total arch replacement (TAR) in patients with TAAAD. Methods A total of 253 patients with TAAAD underwent a central repair operation. Our standard technique was AAR. TAR was performed only when entry existed in the major curvature of the aortic arch and the proximal descending aorta. A total of 169 patients (67%) underwent AAR, and 84 patients (33%) underwent TAR. Hospital death due to initial surgery, dilatation of the distal aorta greater than 5 cm, new occurrence of aortic dissection, any distal aortic surgery, and aortic related deaths were defined as distal aortic events. Results The mortality was 7.1% in the AAR group and 6.0% in the TAR group. Postoperative computed tomography was performed in 162 patients in the AAR group. The false lumen of the residual aortic arch had thrombosed and healed in 94 patients (58%) and remained present in 68 patients (42%). The distal aortic event-free rate in the AAR group decreased from 74% at 5 years to 51% at 9 years, and the rate in the TAR group was 83% at 5 to 9 years (P Conclusions TAR was associated with fewer distal aortic events. We may expand the indications for TAR in stable patients.